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NUR 257 Chronic Exam 4 Galen College Actual
Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Chronic Cardiovascular Disease Management
Q1: A 68-year-old patient with chronic heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. They are currently tolerating Lisinopril and Carvedilol. The patient’s
blood pressure is 110/70 mm Hg, heart rate is 72 bpm, and they report no dizziness. According to
current guideline-directed medical therapy (GDMT), what is the priority action for the nurse
practitioner to maximize this patient's outcomes?
A. Add Digoxin to improve systolic function.
B. Initiate an SGLT2 inhibitor to reduce cardiovascular death and hospitalization.
C. Substitute Carvedilol with Metoprolol succinate.
D. Add Hydralazine and Isosorbide dinitrate.
Correct Answer: B
Rationale: The best answer is B because SGLT2 inhibitors (like empagliflozin or dapagliflozin)
are now recommended as standard GDMT for HFrEF to reduce cardiovascular death and heart
failure hospitalizations, regardless of diabetes status. While Digoxin and Hydralazine/Isosorbide
dinitrate have roles, they are not the priority add-on therapies over SGLT2 inhibitors in a stable
patient tolerating ACE-I and beta-blockers. Carvedilol is already an effective beta-blocker for
HFrEF, so substituting it is unnecessary if the patient is tolerating it well.
Q2: A patient with stage 2 hypertension and a history of stable angina is asking about lifestyle
modifications to help manage their blood pressure. What recommendation by the nurse is most
supported by evidence for non-pharmacological management?
A. Limit sodium intake to less than 2,300 mg per day and engage in moderate aerobic activity
150 minutes per week.
B. Increase intake of potassium-rich foods and perform high-intensity interval training three
times a week.
C. Reduce caffeine intake completely and avoid all alcohol consumption.
,2
D. Follow a high-protein, low-carbohydrate diet to reduce vascular inflammation.
Correct Answer: A
Rationale: The best answer is A because limiting sodium to <2,300 mg (ideally 1,500 mg) and
regular moderate aerobic exercise are cornerstone lifestyle interventions proven to lower blood
pressure. While potassium intake is helpful, high-intensity interval training is not the standard
recommendation compared to moderate activity, and complete cessation of caffeine or alcohol is
not strictly required for all hypertensive patients, only moderation.
Q3: A 55-year-old patient presents with intermittent calf pain that occurs during walking and
resolves with rest. An ankle-brachial index (ABI) is performed, and the result is 0.65. What is the
best interpretation of this finding, and what intervention should be prioritized?
A. The ABI indicates normal arterial flow; the patient should be evaluated for musculoskeletal
causes.
B. The ABI indicates mild peripheral artery disease (PAD); prescribe cilostazol.
C. The ABI indicates moderate PAD; initiate a supervised exercise program.
D. The ABI indicates severe limb ischemia; refer immediately for vascular surgery.
Correct Answer: C
Rationale: The best answer is C because an ABI of 0.65 is diagnostic for moderate peripheral
artery disease. The foundation of management for symptomatic PAD is a supervised exercise
program to improve walking distance and functional status. Cilostazol might be considered if
exercise alone is insufficient, but surgery is reserved for severe disease or critical limb ischemia
(ABI typically <0.4).
Q4: A patient with non-valvular atrial fibrillation has a CHA₂DS₂-VASc score of 3. They are
currently taking Warfarin but find the frequent INR monitoring burdensome. Which of the
following statements regarding the switch to a Direct Oral Anticoagulant (DOAC) like Apixaban
is correct?
A. Apixaban is contraindicated because the patient’s CHA₂DS₂-VASc score is too high.
B. The patient can switch to Apixaban, which does not require routine INR monitoring and has a
lower risk of intracranial bleeding.
C. The patient must continue Warfarin because DOACs cannot be used in patients with a history
of atrial fibrillation.
, 3
D. Apixaban requires bridging with Heparin during the transition from Warfarin.
Correct Answer: B
Rationale: The best answer is B because DOACs like Apixaban are preferred over Warfarin for
non-valvular AFib due to convenience (no routine INR monitoring) and safety profiles (lower
risk of intracranial hemorrhage). A score of 3 indicates a high stroke risk, warranting
anticoagulation, and DOACs are effective in this population. Bridging with Heparin is generally
not required when switching from Warfarin to a DOAC if the INR is therapeutic.
Q5: A patient with chronic venous insufficiency (CVI) has severe leg edema and venous stasis
dermatitis. Which instruction should the nurse include in the teaching plan to manage this
condition effectively?
A. Elevate the legs above the level of the heart for 30 minutes three times a day.
B. Apply compression stockings of 20–30 mmHg upon waking and keep them on all day.
C. Massage the legs vigorously to improve lymphatic drainage.
D. Avoid walking to minimize pressure on the leg veins.
Correct Answer: B
Rationale: The best answer is B because compression therapy is the gold standard for managing
CVI symptoms like edema and dermatitis. Stockings should be applied before getting out of bed
to prevent gravity from causing pooling. Elevation helps but must be combined with
compression; vigorous massage can damage fragile skin; and walking is actually encouraged to
activate the calf muscle pump.
Q6: Data-Based Question: The nurse is reviewing the lipid panel of a 62-year-old patient with
established atherosclerotic cardiovascular disease (ASCVD).
LDL-C: 110 mg/dL
HDL-C: 40 mg/dL
Triglycerides: 150 mg/dL
Current Medications: Atorvastatin 20 mg daily.
The patient reports no side effects. According to 2026 guidelines, what is the next step?
A. Add Ezetimibe to lower LDL-C further.
NUR 257 Chronic Exam 4 Galen College Actual
Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Chronic Cardiovascular Disease Management
Q1: A 68-year-old patient with chronic heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. They are currently tolerating Lisinopril and Carvedilol. The patient’s
blood pressure is 110/70 mm Hg, heart rate is 72 bpm, and they report no dizziness. According to
current guideline-directed medical therapy (GDMT), what is the priority action for the nurse
practitioner to maximize this patient's outcomes?
A. Add Digoxin to improve systolic function.
B. Initiate an SGLT2 inhibitor to reduce cardiovascular death and hospitalization.
C. Substitute Carvedilol with Metoprolol succinate.
D. Add Hydralazine and Isosorbide dinitrate.
Correct Answer: B
Rationale: The best answer is B because SGLT2 inhibitors (like empagliflozin or dapagliflozin)
are now recommended as standard GDMT for HFrEF to reduce cardiovascular death and heart
failure hospitalizations, regardless of diabetes status. While Digoxin and Hydralazine/Isosorbide
dinitrate have roles, they are not the priority add-on therapies over SGLT2 inhibitors in a stable
patient tolerating ACE-I and beta-blockers. Carvedilol is already an effective beta-blocker for
HFrEF, so substituting it is unnecessary if the patient is tolerating it well.
Q2: A patient with stage 2 hypertension and a history of stable angina is asking about lifestyle
modifications to help manage their blood pressure. What recommendation by the nurse is most
supported by evidence for non-pharmacological management?
A. Limit sodium intake to less than 2,300 mg per day and engage in moderate aerobic activity
150 minutes per week.
B. Increase intake of potassium-rich foods and perform high-intensity interval training three
times a week.
C. Reduce caffeine intake completely and avoid all alcohol consumption.
,2
D. Follow a high-protein, low-carbohydrate diet to reduce vascular inflammation.
Correct Answer: A
Rationale: The best answer is A because limiting sodium to <2,300 mg (ideally 1,500 mg) and
regular moderate aerobic exercise are cornerstone lifestyle interventions proven to lower blood
pressure. While potassium intake is helpful, high-intensity interval training is not the standard
recommendation compared to moderate activity, and complete cessation of caffeine or alcohol is
not strictly required for all hypertensive patients, only moderation.
Q3: A 55-year-old patient presents with intermittent calf pain that occurs during walking and
resolves with rest. An ankle-brachial index (ABI) is performed, and the result is 0.65. What is the
best interpretation of this finding, and what intervention should be prioritized?
A. The ABI indicates normal arterial flow; the patient should be evaluated for musculoskeletal
causes.
B. The ABI indicates mild peripheral artery disease (PAD); prescribe cilostazol.
C. The ABI indicates moderate PAD; initiate a supervised exercise program.
D. The ABI indicates severe limb ischemia; refer immediately for vascular surgery.
Correct Answer: C
Rationale: The best answer is C because an ABI of 0.65 is diagnostic for moderate peripheral
artery disease. The foundation of management for symptomatic PAD is a supervised exercise
program to improve walking distance and functional status. Cilostazol might be considered if
exercise alone is insufficient, but surgery is reserved for severe disease or critical limb ischemia
(ABI typically <0.4).
Q4: A patient with non-valvular atrial fibrillation has a CHA₂DS₂-VASc score of 3. They are
currently taking Warfarin but find the frequent INR monitoring burdensome. Which of the
following statements regarding the switch to a Direct Oral Anticoagulant (DOAC) like Apixaban
is correct?
A. Apixaban is contraindicated because the patient’s CHA₂DS₂-VASc score is too high.
B. The patient can switch to Apixaban, which does not require routine INR monitoring and has a
lower risk of intracranial bleeding.
C. The patient must continue Warfarin because DOACs cannot be used in patients with a history
of atrial fibrillation.
, 3
D. Apixaban requires bridging with Heparin during the transition from Warfarin.
Correct Answer: B
Rationale: The best answer is B because DOACs like Apixaban are preferred over Warfarin for
non-valvular AFib due to convenience (no routine INR monitoring) and safety profiles (lower
risk of intracranial hemorrhage). A score of 3 indicates a high stroke risk, warranting
anticoagulation, and DOACs are effective in this population. Bridging with Heparin is generally
not required when switching from Warfarin to a DOAC if the INR is therapeutic.
Q5: A patient with chronic venous insufficiency (CVI) has severe leg edema and venous stasis
dermatitis. Which instruction should the nurse include in the teaching plan to manage this
condition effectively?
A. Elevate the legs above the level of the heart for 30 minutes three times a day.
B. Apply compression stockings of 20–30 mmHg upon waking and keep them on all day.
C. Massage the legs vigorously to improve lymphatic drainage.
D. Avoid walking to minimize pressure on the leg veins.
Correct Answer: B
Rationale: The best answer is B because compression therapy is the gold standard for managing
CVI symptoms like edema and dermatitis. Stockings should be applied before getting out of bed
to prevent gravity from causing pooling. Elevation helps but must be combined with
compression; vigorous massage can damage fragile skin; and walking is actually encouraged to
activate the calf muscle pump.
Q6: Data-Based Question: The nurse is reviewing the lipid panel of a 62-year-old patient with
established atherosclerotic cardiovascular disease (ASCVD).
LDL-C: 110 mg/dL
HDL-C: 40 mg/dL
Triglycerides: 150 mg/dL
Current Medications: Atorvastatin 20 mg daily.
The patient reports no side effects. According to 2026 guidelines, what is the next step?
A. Add Ezetimibe to lower LDL-C further.
